Medicaid. Is it being abused?

hogan4736, BSN, RN · Jun 10, 2004

I make a decided effort to avoid threads on this subject, except when I see what I feel is incomplete or (IMHO) mistaken information.
...BUT, because he is legally and permanently disabled he also get a medicaid suppliment to cover any out of pocket expenses including OTC meds if prescribed. Guess what, I am the one who told his parents to ask for prescriptions for his Tylenol, Motrin and Benedryl. There are a LOT of minor, uncovered expenses that go along with having a disabled or medically fragile child and they add up fast.
"These immigrants" expect to have an interpertor available 24/7 because it is federal law just like it is a federal law that an interpetor be available 24/7 for the deaf. The interpetor does not have to be physically present, it is legal to make use of a language line or TDD but it has to be available. *Personally* the majority of "immigrant" families I have dealt with were private pay and paid their bills because they valued having good healthcare available.

1) My son is speech delayed, and can qualify for all kinds of free services. We attempted to get his helath insurance to cover, to no avail. So we pay out of our own pocket. WHy? Because we can afford it, period. We sold a vehicle that we had (lots more bicycling/bus) so we could pay for it. I consider us fairly well-off too. But the thought of us taking free services didn't sit well when we could afford the 65/week it cost a speech therapist to come to the house. I'm not a big fan of "automatic" qualification based solely on an ICD-9 dignosis. Financial need should come into play. Why should a well-to-do family get free services when they have expendible income? I would discourage asking for scripts for OTC in the above situation, as it seems to be taking from those that may actually need it. The mentality seems to be "It's there, why not use it"

It should be based more on financial need. My point from before (about there needing to be more checks and balances within the Medicaid system) is absolutely true. (I am not referring specifically to kids-r-fun's family, as I know NOTHING of their financial status, though if they can afford OTC meds without an RX, and do without dining out for awhile, for example, then the priorities should change, and my point is underscored)

2) Just because we have a (federal) EMTALA law, doesn't make it reasonably and financially prudent. I speak fluent Spanish as a white man, and would NEVER expect anyone to speak English if I emigrated to said country. I would laugh at them for mandating 24/7 translators. The federal law mandating translators was our government's knee-jerk reaction to the liberal ACLU and it's lawyers, period.

Learn our language, I learned (and have TAUGHT) yours.

Sean

Energizer Bunny · Jun 10, 2004

You know, when filing this bankruptcy that we are working on, we could be adding every single bill that we owe RIGHT NOW, but instead we are paying all of them that we can and only adding our large hospital bills that would never be able to be paid. All the little dr. bills, we are footing ourselves instead of adding them and having our slate wiped clean. Crazy? maybe, but it feels right to be doing what we can rather than just saying "oh to heck with it...the bankruptcy will cover it so let's go buy ourselves a new toy with the money we could have used to pay some of these bills."

I say...if you have the money, use it on your obligations...don't leave it for others to pick up the mess! We learned our lessons all the hard way and will never get ourselves into this mess again, barring a medical emergency of course.

hogan4736, BSN, RN · Jun 10, 2004

You know, when filing this bankruptcy that we are working on, we could be adding every single bill that we owe RIGHT NOW, but instead we are paying all of them that we can and only adding our large hospital bills that would never be able to be paid. All the little dr. bills, we are footing ourselves instead of adding them and having our slate wiped clean. Crazy? maybe, but it feels right to be doing what we can rather than just saying "oh to heck with it...the bankruptcy will cover it so let's go buy ourselves a new toy with the money we could have used to pay some of these bills."
I say...if you have the money, use it on your obligations...don't leave it for others to pick up the mess! We learned our lessons all the hard way and will never get ourselves into this mess again, barring a medical emergency of course.

:saint:

The right thing to do

Hats off to you and yours for stepping up to the plate and displaying a mentality that is a great example for others to follow

sean

BabyRN2Be · Jun 10, 2004

It's really kind of ironic. We are talking about the Medicaid program and it's abuses, just to have the Google ads on some of these pages point us to places where we can get information on Medicaid. I know that it's not on this page (6), but last time I checked it was on page 4 of this thread. With this post, we'll probably see some of them pop up again.

It's out there, people see it, people use it. Sometimes for the right reasons, sometimes not. I am coming to terms with the fact that I will probably not become an RN due to an autoimmune issue which has become extremely disabling for the last 2 months. I want to work so badly, but due to the extreme fatigue and pain, I can not. I feel so sad. In the days in which I could work, I found it extremely gratifying to be supporting myself, being able to pay my bills and having some left over for "fun stuff." Yes, I am on SSI, and it hurts. I miss the feeling of being able to support myself. Right now, those days are behind me. Hopefully one day there will be a new treatment or stem cell procedure or ANYTHING that might alleviate the extreme fatigue and pain I now feel, but for now, I'd give anything for the energy I had in my early 20's - when I could go to school full-time, participate in volunteer activites, work part-time and attend church twice a week.

I believe those days are behind me, my hope is in the future of medicine for now. :crying2:

BuffyRN · Jun 11, 2004

This thread has definitely hit a nerve with me, and unfortunately, I don't see an end to the "it's owed to me" mentality. The system is most definitely abused on a regular basis, and I see it every day in the ED. My biggest gripe of all is entitling every unmarried pregnant female to medical benefits. It does nothing but discourage marriage and perpetuate a vicious cycle that seems to have spun way out of control already. Am I perfect and without faults? No way! But at 20 when I became pregnant, albeit accidentally, my insurance that I had through my employer helped pay the bills. Imagine that... 20 years old and with health insurance. Ok, so it was almost 20 years ago, but it's still possible. My 16 year old daughter has a job at a grocery store that will provide her benefits even as a part-time employee after she's been there a year. I know all employers do not provide insurance and that it can be very expensive, but maybe we need to start reevaluating our priorities.

I have absolutely no problem with working families receiving assistance if necessary. But the ones who do nothing deserve nothing. There just hasn't been a politician brave enough to take a stand and revamp the system because that would obviously be political suicide. My family has been through very hard times, even though the kids don't remember them. We were denied temporary assistance right after my daughter was born due to my husband being laid off his job. Silly me, I had a full-time job at the time and the kids were healthy. I even offered to pay it back once we got back on our feet. My tears meant nothing. My husband picked up a part-time job working at a chicken farm just to be able to feed the kids while looking for a new job. Now I see the abuse daily, and I'd be lying if I said it doesn't harden my attitude. Especially the moms with 4 kids already coming in to the ED with a new boyfriend to get a pregnancy test. Will it ever end?

Of course there's the disability issue... 20 somethings who have hardly worked a day in their life claiming disability due to a back injury while half of the nurses that surround me work every day with degenerative disc disease and herniations. The real topper came about a year ago when this 23 year old male came in for something or other and stated he gets disability because he can't read. I had to walk away on that one.

Thanks for letting me rant... not that it'll make things any better. I'll just go to work tomorrow and try to make a difference in someone's life.

Hellllllo Nurse, BSN, RN · Jun 11, 2004

Is the pope catholic?

Does a bear s@#$ in the woods?

kids · Jun 11, 2004

It should be based more on financial need. My point from before (about there needing to be more checks and balances within the Medicaid system) is absolutely true. (I am not referring specifically to kids-r-fun's family, as I know NOTHING of their financial status, though if they can afford OTC meds without an RX, and do without dining out for awhile, for example, then the priorities should change, and my point is underscored)

When I re-read my post I see that I chould have been more forthcoming about their situation.

They grossed $20K in 2004 including the small SSI stipend the baby gets. They don't have credit cards.

They don't smoke, drink or do drugs.

They drive the 1984 Celeberty my mom bought my daughter for her 18th birthday. That is when they drive, with gas prices the way they are they use public transportation unless the baby has to go somewhere.

The only reason they have basic cable & internet access is because my husband and I pay for it as a gift.

The have a hand me down TV & VCR.

They have a hand me down washer & dryer.

I know the last time they ate a meal out, we went out to lunch as a family the day before I had surgery on April 18th.

Their idea of a vacation is driving 20 miles to spend the weekend camping in the National Forest where it is free.

Their income could be double if both were working. My daughter had to quit her part time job when I had surgery in April and stopped being able to baby sit. I personally interviewed more than 20 providers and not one was willing to accept him due to his having a heart condition.

Basicly, they are just getting by with a little help. But the point is their bills are paid, they have a roof over their heads & nutritious food on the table. Mom pays a $50/month premium for a State subsidized Basic health Plan, Dad is paying 20% of his pay checks for health insurance by choice, he could drop it and take his chances for himself and let the State pick up the tab on the baby but he is being responsable so they don't have to use the ER as their primary care (and leaving the bills unpaid to be written off at public expense).

$4.00 for a bottle of infant Tylenol doesn't seem like much but when you live pay check to pay check and it is 2 days before pay day it might as well cost $100.

Yes, there are a lot of free services for disabled children. I spent a large chunk of my career working with severely disabled children. I appreciate it when families who can aford to pay do so, it frees up funding for the many families who can't.

hogan4736, BSN, RN · Jun 11, 2004

kids, they sound like honest, hard-working people, for whom the free services and cash was meant...

I think I can speak for many here, as they don't fall in the category of freeloaders we are talking about here...

Best of luck to them

And no, you didn't need to be more forthcoming about them, it's your business...Some posters take statments posted here, and personalize them inapproriately...

This is a place to vent about extremes...

kids · Jun 11, 2004

I know Sean, just realized my first post could be interpeted as my supporting Medicaid abuse when my point was it isn't fair to make value judgements without knowing all the details of the (Medicaid recipients) situation.

Dixiedi · Jun 11, 2004

I know Sean, just realized my first post could be interpeted as my supporting Medicaid abuse when my point was it isn't fair to make value judgements without knowing all the details of the (Medicaid recipients) situation.

I think we all knew what you meant in your post but that does not prevent us from venting our frustrations over the abuse to the system we se daily.

I have a neice (by common law marriage to my first husbands brother) raised on welfare who when she came of age married a man on SSI (he's addicted to alcohol) and proceeded to collect SSI herself (she's addicted to whacky weed)!

The two of them live better than I did while raising my kids after my first husband died.

Oh when that happened, knowing these two, it really ticked me off when I was denied assistance. I was 6 months pregnate when my husband died and I just couldn't work. Emotional as well as physical problems with the pregnancy. Anyway, to make a long story short, the only thing I qualified for while waiting for SS and Military benefits to begin was minimal food stamps and that was only AFTER I filed a warrant against my recently deceased husband for non-support! (yes, I did provide a copy of his death certificate to them) I lost my home, ended up selling my car to try to keep my home, and watched as these two (loosely defined) relatives living the good life at my expense!

We understood your post, but it also brought all these negative experiences to the forefront in our minds.

Oh the instances of abuse I've seen over the years. It amazes me. This is a capitalist society. If you don't work, you should live on the street and deserve nothing. Only if you work should be assisted when times are rough.

Peppermint · Jun 12, 2004

Dixiedi · Jun 12, 2004

Yeah!The whole system sucks .I enjoy our conservatives who want the rich to get richer,and let the poor stay poor while they die in wars for them and have any chance of moving up to middle class eliminated by these hogs.Oh I just love so much love the greedy war pigs,and anti-gays,and biggots.They have no idea what it is like to be truly hungry for food,but they are always hungry for money and power and as we have seen will kill for it.JMHO,Okay.Nothing personal.And so off the original topic,sorry.

I don't know where you got that quote for your post that seems to be from me but if you read MY post, you will see that it is not the same as the quote you have in your post.

Yea, it's an easy trick, I could alter your quoted post above too but I believe that would lessen the validity of my statements.

I said nothing about holding the poor back. I have been so poor that I had to choose between rent, utilities and groceries. With young children in the house I chose groceries, FOR THEM! When the gas was turned off I used a hand me down free store electric oven to keep my kids warm. Then, when the eviction notice came I had to let my kids live with foster parents until I could take care of them again.

All this after having been widowed at 28 while pregnate. Remarrying several years later only to find he was abusive when he was actually responsible for something. AND first breaking my foot and being in a non weight bearing cast 9 months and surgery 3 times and that was just 3 months before I broke my back during a robbery/rape.

You go ahead and talk out your pie hole. You don't have a clue what your talking about! Through ALL this the one thing my kids remember is that I always worked to provide for them, I set a good example for them, I love them! I'm still not wealthy, suppose Inever will be but I am quite hopeful the conservatives in this country will lessen my burden by stopping the money they hand out at lazy good for nothings!